Try for free

OHIP Form 4521-84E: Out-of-Country Lab & Genetic Tests

Ordering physicians use this eForm to ask OHIP to approve, in advance, full payment for laboratory or genetic testing performed out of country or in another province because it is not done in Ontario. The ministry reviews the clinical diagnosis, test details, Ontario availability and priority category. Written approval must arrive before the testing is rendered, or the service is ineligible for reimbursement.

Who completes it

A practising Ontario physician completes the parts that apply and e-signs Part 6, attesting that the request was discussed with the patient or substitute decision-maker; physician office staff or the outside laboratory can use the form to add information to an earlier submission. Part 1 records the patient, with a parent, legal guardian or attorney for patients under 16 or represented adults.

Submitting and payment

How to submit it
Submit it electronically, through the online eForm or the downloaded PDF, with a copy of the laboratory requisition and supporting documents (12 MB total); mandatory fields must be complete before the form will submit.
Who pays
No physician fee appears on the form; if approved, OHIP pays in full for the insured test but does not cover the cost of transporting the sample to the outside laboratory.

Good to know

  • Do not use it for testing already performed, for emergency transfers or treatment such as cancer care or MRI (use ON00314E), or for work-related cases, which go to WSIB on Form 8.
  • Category 1 priority is for extremely time-sensitive, life-altering decisions where the lab can return results in under 14 days, such as prenatal testing or tumour profiling that guides treatment.
  • Applications without a copy of the laboratory requisition are incomplete and are not processed, and an expired health card also stops processing, so check the card first.
  • The repository also posts a list of ineligible tests and guidance checklists for selected tests, including fetal and rapid exome sequencing, genetic ataxia, neuromuscular disease and DNA methylation signatures.

Get the official form

Download the current version from the source each time; forms change without notice.

Application for Prior Approval for Full Payment of Insured Out-of-Country (OOC) & Out-of-Province (OOP) Laboratory & Genetics Testing

Demande d'approbation préalable du remboursement de services de santé hors pays/hors province assurés – Analyses de laboratoire et génétiques

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can submit an OHIP out-of-country lab test application?

A practising Ontario physician must complete and e-sign it. If the testing is outside the physician's scope of practice, they confirm that an appropriate specialist, named on the form, has confirmed the regulatory criteria are met. Physician office staff and the outside laboratory can also use the form to add information to an existing request.

Can form 4521-84E be used for testing in another province?

Yes. Despite the out-of-country name, the form covers both out-of-country and out-of-province laboratory and genetic testing, and the physician selects the destination at the start. The out-of-province treatment form (4963-84E) also redirects diagnostic laboratory testing requests to this form.

What must the physician confirm before OHIP approves the testing?

That the test is not part of a research or survey program, is generally accepted in Ontario for someone in the same circumstances, and is not performed in Ontario. The physician also acknowledges that written ministry approval must come before testing, sample transport is not covered, and an approval sets no precedent.